Changes are happening to how Medicare Advantage plans are measured for medication adherence. Starting in measurement year 2026, CMS is introducing sociodemographic status (SDS) risk adjustment into the three Part D adherence measures: diabetes medications, RAS antagonists, and statins.
What's Actually Changing
SDS risk adjustment recognizes a simple truth that we’ve long understood. Not all members face the same barriers to taking their medications consistently.
Starting in this measurement year, your adherence scores will account for factors that significantly impact medication-taking behavior. These include age, gender, disability status, and whether members qualify for low-income subsidy or dual eligibility (LIS/DE).
Here's when these changes take effect.
- In measurement year 2026 (for 2028 Star Ratings): SDS-adjusted adherence measures officially enter the Star Ratings with 1x weighting.
- In measurement year 2027 (for 2029 Star Ratings): SDS-adjusted adherence measures return to 3x weighting.
Yes, you read that correctly. After one year at 1x weighting, adherence measures snap right back to triple weight status in MY 2027.
What does this mean for health plans? Think of it this way. A 40-year-old member with a disability faces different challenges than a 65-year-old who just enrolled. A member on LIS navigates different obstacles than one without financial constraints. CMS is now factoring these realities into how your plan is measured.
Why This Change Matters
For plans serving high proportions of LIS/DE or disabled members, this change creates opportunity. Your results will now be recalibrated for fairer comparisons. But it also increases the complexity of performance management.
Adherence now functions as both a quality driver and an equity lever. Plans serving higher-risk populations will be measured and rewarded more fairly. That's the good news.
The challenging news? You need to understand your member mix at a granular level. You need systems that can track and analyze performance across different sociodemographic segments. You need strategies tailored to the specific barriers your members face.
And here's the critical part: strong adherence performance in 2026 sets you up for success when triple weighting returns in 2027.
Strong Adherence Remains a Strong Advantage
Some plans might look at the temporary 1x weighting and deprioritize adherence. That would be a mistake. Instead, sustaining focus on adherence will drive short and long-term success. Year-over-year engagement keeps members on track and performance strong.
After all, here's what adherence delivers—regardless of its Star Ratings weight.
- Better health outcomes. Consistent medication adherence for diabetes, hypertension, and high cholesterol keeps members healthier. It reduces complications. It prevents costly health deterioration over time.
- Strengthening year-round Stars performance. Even at lower weight, sustained member compliance supports related quality measures. It keeps overall Star scores stable. It positions your plan for stronger performance when triple weighting returns.
- Building trust and retention. When members feel supported in staying adherent, they view your plan as a partner in health. This deepens loyalty and reduces churn in an increasingly competitive market.
The members who are engaged and adherent now are more likely to stay that way in 2027. You're not just managing for one measurement year. You're building sustainable performance.
What To Do Now
The SDS risk adjustment changes don't give you permission to coast on adherence. Rather, they give you a clear roadmap for where to focus your efforts.
- Deploy automated systems that identify at-risk members daily using real-time claims analysis. You need to know immediately when members miss refills or face barriers.
- Define your target population with precision. Focus on members with social and clinical risk factors—particularly those with heart failure, diabetes, COPD, and chronic kidney disease.
- Build care teams proficient in both pharmacy and medical channels. They need to understand local healthcare landscapes and the specific challenges your member populations face.
- Enable comprehensive member support that goes beyond education. Help members complete the medication-taking process by addressing transportation, appointments, and billing issues.
- Establish ecosystem partnerships with clear communication channels across all stakeholders. This includes providers, pharmacies, and strategic partners.
Staying Focused on Adherence and Action
SDS risk adjustment is coming. The changes are significant. But adherence remains as strategically important as ever. As always, plans that understand their member populations, build the right infrastructure, and maintain year-round engagement will thrive under these new rules. Plans that wait or deprioritize adherence risk falling behind just as triple weighting returns.
The measurement year waits for no one. Start building your 2026 adherence strategy now. Learn more at actualmeds.com/solutions#adherence-stars or contact our team today.
